Fecal transplants: Toward a better understanding

In recent years, researchers have learned that gut microbiota play a role in a number of human diseases, including Clostridium difficile infection, irritable bowel syndrome, Parkinson’s disease, and autism spectrum disorder. The revelations have scientists hopeful that fecal microbiota transplantation (FMT) or other therapies that target the gut microbiome can be used to treat these diseases. A new paper investigating why FMT works is now published in mBio, an open-access journal of the American Society for Microbiology.

Clostridium difficileImage/CDC

In the last decade, FMT has been increasingly used to treat patients who have recurrent Clostridium difficile infection, typically caused by a dysbiosis or microbial imbalance of the gut. Microbiota are integral to human physiology and health, and exposure to antibiotics can alter the composition and activity of microbiota, sparking many common health problems. The procedure involves collecting fecal matter from a healthy donor, purifying microbiota from the feces, mixing it with saline solution, and placing it in a patient, usually by colonoscopy.

“Treating patients with recurrent C. difficile infection with microorganisms alone provides cure or reduction of symptoms at a rate many times higher than any drug or chemical that has ever been looked at. These cure rates of 94% and 96% are astronomical, and it is all due to the power of microbes, ” said Michael Sadowsky, PhD, director of the BioTechnology Institute at the University of Minnesota, St. Paul, Minnesota. “I think the future of medicine in the 21st century is to use the power of microbes to cure diseases.”

Eight years ago, Dr. Sadowsky and gastroenterologist Alexander Khoruts, MD, at the University of Minnesota got together to cure C. difficile infection with FMT and later established the Microbiota Therapeutics Program, through which patients can receive FMT. “We have standardized donor material and a rigorous protocol to ensure the material is safe and effective for use. It is produced under a investigational new drug application in a facility that allows us to make it under good manufacturing practices,” said Dr. Sadowsky. Over the last year, roughly 420 patients have undergone a fecal transplant for recurrent C. difficile through the program.

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